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A Year of Learning

I once assisted a group of veterans to improve their health over the course of eleven months using healthy eating and nutrition education. They didn’t like me at first when I removed all the processed food and sugar. After about a month of eating healthier food, their sugar cravings subsided, and they felt better mentally and physically. They also received counseling from mental health professionals.

During that time, I learned a lot about depression and anxiety. One veteran would look like he was feeling good, then come out of his room a couple of hours later in a complete funk. Over time I figured out that he had hypoglycemia–a blood sugar roller-coaster issue. I would give him a healthy snack, and his mood would change very quickly. It was fascinating.

One of the veterans, who had gone through the program, would come back to speak with the veterans occasionally and said that he was “uniquely qualified to come chat because he had been in the deep end of the pool.”

Let’s dive into the deep end of the pool with information.

 

First, definitions of major mood disorders:

Anxiety is defined as “an emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure.”

Generalized anxiety disorder (GAD) involves a persistent feeling of anxiety or dread, which can interfere with daily life. This is not the same as occasionally worrying about everyday things or experiencing anxiety due to stressful life events. People living with GAD may experience anxiety for months or even years.

According to the National Institutes of Health, symptoms of GAD may include:

• Feeling restless, wound-up, or on-edge
• Being easily fatigued
• Having difficulty concentrating
• Being irritable
• Having headaches, muscle aches, stomachaches, or unexplained pains
• Difficulty controlling feelings of worry
• Having sleep problems, such as difficulty falling or staying asleep
• Startle easily

There are many types of anxiety disorders including, but not limited to, panic disorders, social anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder.   Millions of people are affected by anxiety disorders, both adults and children. Anxiety is frequently comorbid with depressive disorders.

A side note on the National Institute of Mental Health website, the only nutrition recommendation they have is to watch your caffeine levels. We need to do better.

Depression is defined as “a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think, and behave and can lead to a variety of emotional and physical problems.”

According to the Centers for Disease Control (CDC) symptoms of depression can be:

• Feeling sad or anxious often or all the time
• Not wanting to do activities that used to be fun
• Feeling irritable‚ easily frustrated‚ or restless
• Having trouble falling asleep or staying asleep
• Waking up too early or sleeping too much
• Eating more or less than usual or having no appetite
• Experiencing aches, pains, headaches, or stomach problems that do not improve with treatment
• Having trouble concentrating, remembering details, or making decisions
• Feeling tired‚ even after sleeping well
• Feeling guilty, worthless, or helpless
• Thinking about suicide or hurting yourself

Types of depression include but are not limited to persistent depressive disorder, postpartum depression, seasonal affective disorder, psychotic disorder, and bipolar disorder. With both depression and anxiety, causation can be genetic, biological, environmental, and/or psychological.

According to the World Health Organization, “Depression is a common illness worldwide, with an estimated 3.8% of the population affected, including 5.0% among adults and 5.7% among adults older than 60 years. Approximately 280 million people in the world have depression. Depression is different from usual mood fluctuations and short-lived emotional responses to challenges in everyday life. Especially when recurrent and with moderate or severe intensity, depression may become a serious health condition.”

The emergence of the COVID-19 pandemic has created an environment where determinants of poor mental health have been exacerbated. We are not sure yet how children will be affected long-term. If you want to read more about mental health and Covid-19, click here.

This is a quote that someone told me long ago, and just makes a lot of sense. This quote is often credited to Lao Tzu: “if you are depressed, you are living in the past. If you are anxious you are living in the future. If you are at peace you are living in the present moment.” Food for thought.

Depression and anxiety are major mood disorders, but everyday stress can affect your mood and life as well. I wrote this article years back when I was in the middle (versus the deep end) of the pool. I learned from my own experiences and from working with the veterans that an improved diet helps. Perhaps it might be helpful for you.

 

Considerations

For both depression and anxiety, lifestyle components may help with symptoms, including relaxation techniques, meditation, yoga, acupuncture, and exercise. Few organizations delve into depression and anxiety and the correlation to healthy eating, but fortunately, this correlation is gaining attention.

 

Keep it Steady — The importance of Regular Meals

Repeated and rapid increases and decreases in blood glucose could increase the risk for depression and/or anxiety. Refined carbohydrates, which includes sugar, can cause this roller coaster. One study puts it this way: “High dietary glycemic load, and the resultant compensatory responses, could lower plasma glucose to concentrations that trigger the secretion of autonomic counter-regulatory hormones such as cortisol, adrenaline, growth hormone, and glucagon. The potential effects of this response on mood have been examined in experimental human research of stepped reductions in plasma glucose concentrations conducted under laboratory conditions through glucose perfusion. These findings showed that such counter-regulatory hormones may cause changes in anxiety, irritability, and hunger. In addition, observational research has found that recurrent hypoglycemia (low blood sugar) is associated with mood disorders.”

 

Healthy Eating, Inflammation and Mood

Chronic inflammation (versus acute inflammation which is your body’s defense and repair system) plays an important role in the development of chronic diseases which includes heart disease and cancer. In one study: “In recent years, abnormal inflammatory processes have been identified as putative pathophysiological mechanisms and treatment targets in mood disorders, particularly among individuals with treatment-resistant conditions.”

Various nutrients and foods have been shown to modulate inflammation, so your dietary patterns play a role in the regulation of chronic inflammation.

Common inflammatory foods include:

• Refined carbohydrates, which includes sugar, of course.
• Fried foods such as French fries
• Sugar-sweetened beverages such as soda
• Processed meats

Common anti-inflammatory foods are:

• Green leafy vegetables
• Cold-water fatty fish like salmon, mackerel, and sardines
• Fruits such as berries, cherries, and oranges
• Nuts
• Olive oil

Variation in Your Diet

Most Americans consume the same foods day after day, which can equate to a lack of nutrients -macronutrients (protein, carbohydrates, and fats) and micronutrients (vitamins and minerals, antioxidants). According to the CDC, only 1 in 10 adults consumed enough fruits and vegetables daily. This study and the associations pointed out depend on a wide range of nutrients. “Consistent evidence from observational studies has pointed out the association between a ‘healthy’ diet, generally characterized by a higher intake of fruits, vegetables, legumes, nuts, whole grains, and good quality sources of protein (i.e. fish and/or seafood), and decreased risk of mood disorders and the parallel association between a ‘Western’ diet pattern and increased risk.”

The omega-3 fatty acids — eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) — are thought to have the most potential to benefit people with mood disorders. One study (but there are many others) states that: “Omega-3 polyunsaturated fatty acids (PUFAs), such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are essential nutrients that have potential preventive and therapeutic effects on psychiatric disorders, such as anxiety and depression.”

 

Protein

A study performed by University of Korea in Seoul, California Institute of Technology  concluded that: “Our study suggests that increasing calories from protein in the daily diet is associated with a lower prevalence of depression in adults in the United States and South Korea.” The interesting part of this study is that Americans eat much more protein than Koreans, but additional protein helped with depression symptoms. I am not suggesting that if you already consume ample protein that you should consume more. A well-rounded healthy diet is best but do speak with a nutritionist and your doctor to determine what a healthy protein intake is for you.

 

Overweight and Obesity

There are many studies that show that being overweight is associated with an increased risk of depression.

One study (a meta-analysis that looks at many studies) concluded that: “The leading hypothesis for why obesity is associated with depression is through inflammation because this is a core feature of depressive illness and excessive adipose tissue increases the production of proinflammatory cytokines. Indeed, recent preclinical research has shed further light on pathways through which obesogenic diets impact mental health, demonstrating that dietary-induced obesity reduces insulin signaling in the brain and increases neuroinflammation, resulting in depressive-like behaviors in rodent models. This is supported by recent research in human adolescent samples, which has demonstrated that the protective effects of a healthy diet on depression risk is conferred through reduced body mass index and associated inflammation.” I believe that it’s best not to focus on weight loss and that when a healthy diet is maintained, weight loss, if needed, will be a side effect. To read the meta-analysis, click here.

 

Vitamin D

You can read the below and understand that most of our vitamin D (you’ll read that it is actually a hormone) comes from the sun. People with dark skin, who are inside most of the time or who live in northern climates will most likely be low on vitamin D. There are many studies that show the positive effects of vitamin D, but it is fat-soluble, meaning it can be stored, unlike water-soluble vitamins, like vitamin C, which is not stored. You should have your vitamin D level checked and have your doctor ascertain an appropriate amount for you.

“Vitamin D is actually a hormone rather than a vitamin; it is required to absorb calcium from the gut into the bloodstream. Vitamin D is mostly produced in the skin in response to sunlight and is also absorbed from food eaten (about 10% of vitamin D is absorbed this way) as part of a healthy balanced diet.”

“Vitamin D, a fat-soluble vitamin, plays a role not only in calcium and phosphate homeostasis but also in several other functions, including cell growth and neuromuscular and immune function. The deficiency of vitamin D is highly prevalent throughout the world and has been suggested to be associated with an enhanced risk of major depressive disorder (MDD) and anxiety disorders.”

Serotonin and Dopamine are both neurotransmitters, meaning they are chemical messengers that regulate many functions and processes in your body.

Dopamine offers the feeling of pleasure when you act on a craving. An example: you want Ben and Jerrys, you eat the whole pint, you feel better for about 10 minutes, thanks to dopamine, and then you feel bad because you know that for a myriad of reasons you should not have consumed a pint of Chunky Monkey. Dopamine system dysfunction is linked to certain symptoms of depression, such as low motivation. Perhaps remind yourself that pleasure (generally short-term) is not the same as happiness.

Serotonin is involved in how you process your emotions, which can affect your overall mood. Serotonin is made from the amino acid tryptophan. About 95% of your serotonin is produced in your gastrointestinal tract, so gut health is important for serotonin production, which also helps you sleep.

 

Stay Hydrated

We all know that adequate water intake is essential for health. It’s necessary for your digestive system—your gut, remember that most serotonin is made in your gut—and for many other bodily functions. Simply put: “This intervention study demonstrated that a daily water intake increase led to a significant mood improvement in habitual low drinkers, who reported less fatigue, less confusion, less thirst, and who tended to be less sleepy. Conversely, habitual high drinkers forced to reduce their daily water intake indicated that the restricted water intake negatively impacted their mood state; they indicated being more thirsty, less calm, less content, less vigorous, and reported lower positive emotions.”

 

Gut microbiome

Your gut is also referred to as your second brain. The gut bacteria can affect the brain and the brain can influence the gut microbiome. This is a simple summary: “Gut bacteria also produce hundreds of neurochemicals that the brain uses to regulate basic physiological processes as well as mental processes such as learning, memory and mood. For example, gut bacteria manufacture about 95 percent of the body’s supply of serotonin, which influences both mood and GI activity.” Do read the entire article by the American Psychological Association.

 

Medications

To understand antidepressants and antianxiety medications, you should speak with your doctor. Some basic information about medications is available here.

 

Seasonal Affective Disorder (SAD)

Seasonal affective disorder (SAD) is a recurrent major depressive disorder with a seasonal pattern usually beginning in fall and continuing into the winter months.  One study states that “People with SAD can feel sad, irritable, and may cry frequently; and they are tired and lethargic, have difficulty concentrating, sleep more than normal, lack energy, decrease their activity levels, withdraw from social situations, crave carbohydrates and sugars, and tend to gain weight due to overeating.” Speak with your doctor about light therapy, vitamin D, and for tips to stave your carbohydrate and sugar cravings.

 

Exercise

We all know that exercise is good for us. The CDC recommends 150 minutes of physical activity each week. It could be 30 minutes a day, 5 days a week. You can spread your activity out during the week and break it up into smaller chunks of time. We suggest something else to consider: if possible, have your exercise time be outside in nature. Nature is calming and healing.

 

Tests to determine inflammation

One of the more common blood tests to assess overall inflammation is high-sensitivity C-Reactive Protein or hs-CRP. Foods that raise the level of inflammatory markers like hs-CRP are regarded as pro-inflammatory, while those associated with reduced levels are considered anti-inflammatory. Speak to your doctor about having this test done. If that is not possible, follow an anti-inflammatory diet and pay attention to how you feel.

 

Summary

 

Ways of Eating

We would like you to keep in mind that the Mediterranean Diet is just one traditional diet. Many old ways of eating across the globe are healthy, and there are similarities such as little to no processed foods and limiting sugar. There are also the lifestyle components that are health-supporting such as the benefits of slowing down and eating a meal together. They say that the Mediterranean diet is associated with better mental health than unhealthy eating patterns, such as the Western diet. Why is this?

A Mediterranean diet is rich in fruits, vegetables, olive oil, whole grains, and lean protein such as chicken and fish and low in red meat and unhealthy fats.

“With regard to whole-diet interventions, it is interesting to consider the prevalent finding that the weight loss, fat reduction, or Mediterranean diets trialed so far all appear to confer similar beneficial effects on depressive symptoms. While this may indicate a lack of specificity, it should be acknowledged that each of these interventions, although differing in stated aims, generally has some key factors in common. Specifically, all of these interventions generally involve decreasing the amount of refined, processed calorie-dense foods, while increasing intake of nutrient-dense natural-occurring fiber and vegetables.”

Even if future research determines that a Mediterranean diet doesn’t influence depression risk, there are still numerous other reasons to adopt this eating plan. “For instance, the Mediterranean diet has also been associated with lower blood pressure, better cognitive function, and lower incidence of diabetes and cardiovascular events,” says Chocano-Bedoya. “I would recommend an overall healthy, high-quality dietary pattern, such as a Mediterranean-style diet, not only for the potential to reduce depression risk but also for overall lower risk of other chronic conditions, which in themselves may later increase the risk of depression.”

 

How Foogal Can Help

As mentioned above, causation for both depression and anxiety can be genetic, biological, environmental, and/or psychological. We can help with the environmental category—what you put into your body—your healthy diet. Keep in mind that “Genes are regulated by complex arrays of response elements that influence the rate of transcription. Nutrients and hormones either act directly to influence these rates or act indirectly through specialized signaling pathways.” In other words, food can affect your genes.

Food clearly affects your biology. Read here. This brings us to psychological factors. This is the chicken and the egg scenario. Our mood can affect our food choices –feeling stressed? Ice cream anyone?– just as our food choices can affect our mood—I feel sluggish and unhealthy after eating all that ice cream, and a little depressed. It’s a vicious circle.

At Foogal, we pride ourselves on helping you obtain or maintain your health. We have filters to ensure that you do not see recipes that contain highly processed foods or too much sugar. We offer delicious recipes that protect the liver and feed the gut, which in turn may improve your depression or anxiety symptoms.

 

Further resources and reading:

Hypoglycemia Support Foundation. I am honored to be on the Board along with Foogal’s Chief Medical Officer, Dr. Robert Lustig.

https://hypoglycemia.org/leadership/

https://hypoglycemia.org/real-food-science-health/